Before Your Pregnancy: A 90-Day Guide for Couples on How to Prepare for a Healthy Conception (2nd Ed.)

In this revised and expanded edition, Ogle, a registered dietician, exercise physiologist, and personal trainer, and Mazzullo, a practicing ob-gyn and assistant professor of obstetrics and gynecology at Northwestern University Medical School, urge couples considering pregnancy not just to conceive but to preconceive. According to the authors, the 90-day period before conception is a critical time for couples to assess emotional, financial, environmental, gynecologic, genetic, nutritional, and physical preparedness. In this edition, they've added, among other things, a section called twelve steps to a welcoming womb, new research on blood sugar control, updates on herbs and supplements, a pre-conception menu, expanded gynecological and men's health sections, and a new chapter on infertility. They cover the effects of such habits as smoking, drinking, drugs, and caffeine; address the work and home environment, nutrition, and exercise; and offer discussions of such practical matters as getting health insurance and travel ideas before baby comes. The sections on exercise and diet include not only general guidelines but also specific warnings (i.e., unpasteurized milk, Bikram yoga, and snowboarding are pre-conception no-nos). The authors present a well-rounded approach that will help parents-to-be play an active role in comprehensive planning for a healthy baby. (June)
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Now completely revised and updated, the classic guide that helps mothers- and fathers-to-be conceive more easily and boost the odds of a healthy pregnancy
 
Covering preconception and interconception (between-pregnancy) well-being for women and men, Amy Ogle and Lisa Mazzullo draw on new research from their complementary fields of expertise and reveal how good preconception health can lower the risk of pregnancy complications and improve lifelong health. Why a ninety-day guide? It takes that long for sperm to mature, and at least that much time for the prospective mother to ensure that her body becomes pregnancy-ready. In a warm, intelligent style, the authors address up-to-date topics such as age, heredity, vaccinations, supplements, and weight. In easily accessible chapters, this guide covers such topics as
 
• Nutrition: meal makeovers plus new facts (and fiction) about fish, omega-3s, vitamins, and herbs
• Personal readiness: how to assess emotional, financial, and physical readiness, including a preconception-friendly exercise program, plus advice for avid athletes
• Becoming an informed patient: choosing a doctor, insurance coverage, baby-friendly medications, and the latest genetic screening guidelines
• Women’s health: expanded coverage of gynecologic and medical conditions affecting fertility and pregnancy (including bariatric surgery and physical disabilities), and steps to create a welcoming womb by optimizing immune health
• Environment: a roundup of environmental exposures and travel tips
• Men’s health: practical lifestyle advice for men to help maximize the number and health of sperm
• Conception: clear signs that predict when to “start trying,” and the truth behind common myths
• Infertility: reassuring options for reproductive assistance
• Interconception health: the best plan for pregnancy recovery, before trying for another
• Resources: questionnaires for your preconception medical visit, and charts to track fertility signs

“Many people don’t realize that the most important time for doing things to improve the chances for having a healthy pregnancy outcome is actually before conceiving that pregnancy. Before Your Pregnancy is a wonderful and invaluable resource for couples planning a pregnancy. I highly recommend this book.”
—Peter Bernstein, MD, MPH, Professor of Clinical Obstetrics and Gynecology and Women’s Health, Director of the Fellowship Program in Maternal Fetal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine
 
“Optimal preconceptional care is essential for a successful pregnancy. As Amy Ogle and Lisa Mazzullo have shown, in this beautifully executed book, there is much more to preconceptional care than folic acid supplementation. This is a comprehensive piece that synthesizes all of the important medical, dietary, and lifestyle considerations for families anticipating pregnancy. Before Your Pregnancy is a wonderful resource that I will be thrilled to share with my patients.”
—Clarissa Bonanno, MD, Columbia University Department of Obstetrics and Gynecology
 
“Before Your Pregnancy is a comprehensive, refreshing, and contemporary review of the complex issues that impact women and their pregnancies. With so much misinformation concerning pregnancy now available 24/7 on the Internet and other media outlets, this book should be required reading for women planning a pregnancy and their health care providers. It is well written and evidence based and is an enjoyable and educational read. I wholeheartedly recommend it!”
—Lee P. Shulman, MD, The Anna Ross Lapham Professor in Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University
 
“Before Your Pregnancy will be recommended to all my fertility patients as an evidenced based, friendly, participative guide to a successful conception and healthy pregnancy. It is by far the most complete resource I have reviewed, and I am certain it will provide a great benefit to many couples and the health of their future children!”
—Judy Simon, MS, RD, CD, CHES, Fertility Nutrition Specialist, Mind Body Nutrition PLLC and University of Washington Medical Center
 
“I congratulate the author-clinicians for delivering this comprehensive, up-to-date, evidence-based medical guide to optimizing a couple’s health in order to achieve the best possible outcome for their pregnancy. Every patient in my practice could benefit from reading this book.”
—Christopher Sipe, MD, Fertility Center of Illinois
 
“What makes this book a standout is the encouraging tone. I have read many books about pregnancy and fertility, and this one feels like the advice that a caring, trusted friend would give you. Infertility is a stressful and emotional issue, and this book eases your mind at the same time that it arms you with the knowledge and information you need to prepare your body and mind for pregnancy. Whether you have struggled with infertility or not, Before Your Pregnancy is a valuable resource for women whose goal is to be healthy and (eventually!) pregnant.”
—Margaret G.
 
“Finally! A comprehensive yet easy-to-read book to help women and men prepare emotionally and physically for the joy of pregnancy! I would recommend this book to anyone who is thinking about having a baby, including my clients who have PCOS or struggle with eating disorders and body-weight issues.”
—Angela Grassi, MS, RD, LDN, co-author of The PCOS Workbook: Your Guide to Complete Physical and Emotional Health and author of The Dietitian’s Guide to Polycystic Ovary Syndrome
 
“A comprehensive and informative book serving as a knowledge source for nurse practitioners and women of childbearing age. Before Your Pregnancy is something I’ll share with my graduate students.”
—Janie Daddario, MSN, WHNP, Director of the Women’s Health Nurse Practitioner Program, Vanderbilt University School of Nursing
 
“Ogle, a registered dietician, exercise physiologist, and ACE-certified personal trainer, and Mazzullo, an OB-GYN, wrote the first edition of this book in 2002. Here, they present the latest information and research to help couples prepare their bodies, minds, and bank accounts for the arrival of a child. The authors begin with chapters that help couples examine their stress levels, lifestyle habits, and home and work environments. They move on to how to choose a doctor or midwife, medical conditions affecting conception, genetic factors, chronic health conditions, and things that men can do to assure conception. Good nutrition, exercise, and the right drugs and supplements are vital for both partners, the authors hold. There is also coverage of infertility issues. Appendixes offer income and expense worksheets, dietary reference intake charts, charts for tracking menstrual cycles, and resources for safety information. VERDICT An outstanding book that fills a gap in public and consumer health library collections. There are many books on pregnancy and infertility, but none addresses preparation for conception in depth as this one does.”
—Barbara M. Bibel, Oakland P.L., CA, Library Journal

Amy Ogle, M.S., R.D., is a registered dietitian, exercise physiologist, and ACE-certified personal trainer.
 
Lisa Mazzullo, M.D., is a practicing OB/GYN and assistant professor of OB/GYN at Northwestern University Medical School.

I N T R O D U C T I O N
Don’t Just Conceive: Preconceive!

It is every prospective parent’s dream to have a child who is happy, bright, engaging, and healthy enough to experience life to its fullest. Whether you are thinking of trying to conceive for the first time or have been down this road before, we would like to help you improve your chances of making this dream come true, just as we have for countless men and women under similar circumstances. In fact, it was in the year 1995 that the idea for Before Your Pregnancy came into being. At the time, Amy, a registered dietitian, exercise physiologist, and personal trainer, was working with patients and private clients who were pregnant—with or without complications—or within a year or two of having had a child. She was impressed by their motivation and surprised by the number of times she heard the remark “If only I knew then what I know now, I’d have taken better care of myself before I got pregnant.” It got her thinking about why there wasn’t more emphasis from the medical community on health during the months before conception. After all, the scientific literature was brimming with new information on ways women and men could prepare their bodies for conception and improve the baby’s health, actions that often made a difference only if begun one to three months before trying to conceive. Unfortunately, virtually none of this information was widely available to the general public.

Determined to get the word out, Amy wrote and produced a video and accompanying booklet entitled Before Your Pregnancy that provided preconception nutritional and exercise advice. (Coincidentally, she became pregnant while making the video, giving her a chance to practice what she preached!) One of the professionals who edited the text, Dr. Lisa Mazzullo, a board-certified ob-gyn and assistant professor of obstetrics and gynecology at Northwestern University Medical Center, happened to teach “Maybe Baby” classes at her hospital, covering the same topics from a medical and psychological point of view. The response to the video and preconception classes was so great that we, Amy and Lisa, ultimately decided to pool our expertise and create the book you hold in your hands, a complete resource for couples considering having a baby.

Most preconception discussions between patients and doctors—if they occur at all—are limited to “Begin taking your folic acid, and have fun!” The fact of the matter is, however, that there are many things you can do to improve your physical health and psychological readiness in the critical ninety-day period before conception. In this book we’ll help you to thoroughly assess your emotional, financial, environmental, gynecologic, genetic, nutritional, and physical preparedness and provide detailed advice on how to improve in each area. If you follow our preconception guidelines, you will also improve your odds of
• Conceiving more easily
• Conceiving a healthier baby
• Giving the baby a “smooth landing” during implantation in the uterus and ensuring a strong placenta—the vascular connection between mom and baby
 • Having a healthier pregnancy
• Recovering more easily in the postpartum period
• Decreasing your child’s risk for certain childhood and adult health problems

You may be wondering why certain baby-friendly actions must be implemented in the months prior to conception. After all, until fertilization occurs, there isn’t even a baby in the picture. Well, the egg and sperm that will eventually become that baby go through crucial genetic preparations in the weeks before conception, and you want these to occur under the best circumstances. Because genetic defects do not all occur randomly, the prospect of having some control over this risk is immensely empowering. Also, consider that most birth defects—many preventable—occur between seventeen and fifty-six days after conception, often before a woman becomes aware that she is pregnant. Preconception readiness primes the woman’s body so the baby can thrive in those early weeks of development.

Here’s something else that’s fascinating. The maternal body directs most of its focus and energy into building and “remodeling” the placenta during the first three months of pregnancy; it’s like building a solid foundation with the best materials before pouring much energy into the structural details. The placenta has always been described as the critical component that orchestrates nutrient delivery and waste disposal via the umbilical cord. It also tries to run interference, if harmful substances get into the maternal bloodstream. What you may not know is that a healthy placenta that works in sync with the maternal immune system can be key to keeping the fetus “on board” and growing well for the full forty weeks of pregnancy.

This is an exciting area of ongoing research, one with many potential implications for preconception and pregnancy health. You’ll see more discussion about this in a new feature beginning on page 163.

Take it from us: it is also a lot easier to continue healthy habits during pregnancy and beyond if you already have them in place before you are pregnant. And eventually your children will learn the healthy habits that you, their parents, model.

We cannot emphasize enough that the preconception actions of both partners, not solely the woman, can make a difference in the health of their future child. Ultimate success comes when you both feel equally important and act synergistically as a team. You will find a lot of information in this book to help the prospective dad become healthier, better informed, and more involved in what lies ahead.

We share your enthusiasm for wanting to make your body a safe and healthy place for your baby to thrive.

HOW TO GET THE MOST OUT OF OUR BOOK

Are you planning your pregnancy several months to a year in advance, or have you already started trying? How you use this book largely depends on your personal time frame for conception. As mentioned earlier, we recommend following these guidelines for at least ninety days before trying to conceive. This time frame is ultimately best for most situations but may not be practical or necessary in all cases; we’ll make a point of noting when something should be heeded earlier or later than the ninety-day timeline. Depending on what you discover from this book about your current state of preconception readiness, you may come to the conclusion that it is in your interest to postpone your plans for a few months. In the grand scheme of things, a relatively short delay is a small price to pay for improving your odds for a healthier outcome.

We’ve organized this book according to how you might naturally approach preparing for pregnancy. Long before you and your partner discuss preconception readiness with a health care professional, you’ll determine whether you’re mentally and financially ready to welcome a new being into your life. At the same time, you may start looking at your lifestyle habits (e.g., smoking, drinking) and your home and away-from-home environments with questions of wholesomeness and safety in mind. After these initial considerations, we get to the heart of preconception health, nutrition, and fitness for women and men. Finally, Chapter 17, “Romancing the Egg,” can be referred to when you’re both ready to start “trying”; there’s now a fast-track (“zoom” ) and laid-back (“Zen” ) approach, depending on your personal needs.

It might be helpful for you to take a peek at “Romancing the Egg” (Chapter 17), just to get an idea of where you’re headed and find out your “Fertility ‘Personality’ Profile.” The profile is there to guide readers who have completed the majority of the book—and their ninety days of preconception planning—so we kept it there despite the urge to place it earlier.

Should you experience infertility, a new chapter (Chapter 18) will help reassure and guide you, including new information and specific cross-references to other parts of the book that might have initially only been skimmed. Then we delve right into ways to reassess, complement your own efforts, and get the right help to achieve your goal of having a baby.

Before Your Pregnancy is meant to be an interactive book. We encourage you to write in the blank spaces, margins, and charts. Dog-ear plenty of pages, and highlight pertinent advice with a pen or colored marker. Approach this as you would a delectable barbecue dinner: you cannot thoroughly enjoy the meal if you and your napkin remain spotless.

To further encourage you to participate in the learning process we feature exercises called Practical Applications. As the term suggests, these typically take the topic under discussion into your own specific circumstances. For example, in the section on women’s medical issues, one Practical Application is to look in your medicine cabinet and write down all the medications, herbs, and supplements you find, familiarize yourself with what we recommend about them, and note which ones you should ask your physician about.

Although the information in this book is written for couples, we address the prospective mother as “you,” unless stated otherwise. We’re making the assumption that, for the most part, it will be women who read this book and then share pertinent portions with their partners. (Kudos to you men who ran across this book first.)

You will also notice that we use several interchangeable terms throughout the book. For example, the yet-to-be-conceived baby and the baby while in the womb both are referred to as either the fetus or the baby. Your primary health care provider is referred to most of the time as a doctor or physician but could just as easily be a nurse midwife, nurse practitioner, or physician assistant. Finally, we use the terms partner, husband, wife, baby’s mother/father, mate, or spouse interchangeably.

Many of the recommendations for pre-pregnancy are also applicable later on, often for completely different reasons. When that is the case, you will see boxes titled For Future Reference with symbols indicating when the reference is to “during pregnancy” , “after delivery” , or “family life” with children . These are for all of you information pack rats to tuck in the back of your minds for future use during the pregnancy and postpartum period. If you are the type who was driven crazy in school by a teacher who periodically went off on tangents, feel free to skim these!

This book will also help you become a more active participant in your health care. It will assist you in organizing any questions you may have for your doctor and help to clarify what he or she is telling you. That way you can make the best use of your appointment time and will be less likely to walk out of the office saying, “Oh, I wish I had asked her about x, y, and z.”

SETTING A NEW PRECEDENT

As you put our guidelines into action, remember that the practice of preconception care is still relatively new in comparison to the well-established practice of prenatal (during pregnancy) care—so new, in fact, that you may periodically be faced with skepticism from your family, friends, and even some health care workers. Your partner may question the necessity of it. Don’t be swayed or discouraged if people say that couples have been having healthy babies for hundreds of thousands of years and very few of them did anything to plan ahead for conception; or if they point out that there are women who abuse their bodies with drugs and an unhealthy lifestyle and then have healthy babies despite it all. It’s true that women give birth to healthy babies under less than ideal circumstances—thank goodness for this general resiliency! Even so, preconception planning does improve one’s overall odds for giving a baby a head start from the very moment of conception. The particulars of how and how much it helps will vary among individuals.

 Occasionally we encounter a prospective parent who finds the thought of planning for pregnancy unappealing because of religious or cultural beliefs. Or you and your partner may prefer to be spontaneous and just see what happens. However, the words planning and spontaneity are not diametrically opposed. Although some couples will meticulously plan to “start trying,” true preconception readiness is a lifestyle practice in case pregnancy should occur. Considering that almost half of all pregnancies are unplanned, this type of general pre-pregnancy readiness is a good idea for any couple of childbearing age. Following these guidelines will mean that you and your partner will be optimally ready to create a baby at any time, whether you intend to become pregnant or not.

Over the course of our careers we have counseled thousands of couples who, like you, are planning to start trying to get pregnant. Their experiences have inspired the many scenarios we have created to illustrate the information in this book. In addition, many experts outside our respective fields—psychologists, social workers, financial planners, public health advocates, geneticists, urologists/male infertility specialists, immunologists, pediatricians, and herbal researchers—have generously shared their knowledge with us to make this book as complete a resource as possible. We extend our gratitude to all who have contributed to our understanding of what it means to want a child and to selflessly act in his or her favor before conception. We thank you, too, for caring enough to learn, as we have.

Amy Ogle, MS, RD